Tuesday, October 31, 2006
Surprise! Tobacco-sponsored anti-smoking ads don't work
And may actually encourage youths to smoke. Devilish reverse psychology from the tobacco industry.
Posted by Kevin |
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Is Exubera Pfizer's white elephant?
It's starting to look that way. It didn't really stand a chance.
Posted by Kevin |
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Saw III causes a theater to call EMS three times
The film was too horrific for some.
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A hospice patient is stabbed to death
Apparently by a family member. Tragic.
Posted by Kevin |
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Newsflash: The majority of patients are non-compliant
50 to 75 percent don't follow their doctor's instructions:Either they don't fill a prescription, or they don't change a dressing, or they forget to take their pills, or they fail to follow instructions in some other way. Even more surprisingly, the people with the chronic problems, such as high blood pressure, have the highest non-compliance rates. Children, too, are often victims of caregivers who fail to follow a doctor's instructions.
Posted by Kevin |
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Lufthansa's new selling point: "There is a doctor on board"
80 percent of flights have a doctor on board.
Posted by Kevin |
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Claudia Henschke fails evidence-based medicine 101
She is a proponent of CT-scans for early lung cancer detection, and doesn't get that randomized-controlled studies are the only standard. The rules can't be rewritten for her cause:"I don’t get what the resistance is," Dr. Henschke said.To her, it is a matter of simple logic: the earlier cancer is found, the better the odds of a cure. CT finds lung cancer early. So why not use it? . . .
. . . It may be reasonable to insist on randomized controlled trials for treatments, but not for diagnostic tests, Dr. Henschke says. Her views are unconventional, to say the least. Some researchers say she is trying to rewrite the rules of science.Dr. Barnett Kramer, associate director for Disease Prevention at the National Institutes of Health, took vigorous exception to her assertions, insisting that randomized controlled trials are the only way to find out for sure whether a test or a treatment really works.
Posted by Kevin |
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Should PFOs be sealed?
The medical device makers certainly hope so, they have lots of profit at stake. Patriots linebacker Tedy Bruschi had his sealed, chronicled here extensively.
Posted by Kevin |
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Multidetector CT scan - the new ER triage test
It's touted as the 15-second heart scan that saves lives. Of course, cost isn't mentioned. You bet that once it's available, it will be a routine cya ER test. And we wonder why health costs are out of control.
Posted by Kevin |
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Grand rounds is up
Doctor Hebert's Medical Gumbo hosts this week. Come get the weekly best of the medical blogosphere.
Posted by Kevin |
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Monday, October 30, 2006
Wonderful article on the NEJM
Boston Magazine writes on the controversies and challenges facing The Journal. Primarily on its relationship with pharmaceuticals, and its association with the Massachusetts Medical Society. Required reading.
Posted by Kevin |
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Anti-vaccine activists: "They are enemies of the people"
I have maintained that not vaccinating children is akin to child abuse. Here's taking it one step further:Respectful Insolence and Kevin, M.D., characterize parents who refuse to vaccinate their children as guilty of child neglect. I'll go one step further. These parents' selfish decisions are hurting more than their own children. By defeating one of the core missions of public health -- that of conferring herd immunity from easily preventable communicable diseases -- these parents are harming entire populations. They are hurting other people's children. To put it coarsely but accurately, they are enemies of the people.
Posted by Kevin |
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UnitedHealth: Not only physician-unfriendly, but one of the worst health plans in the nation
Remember, their priority is money, not health care, as seen in the recent NCQA rankings:Health care is a public good, not just an industry, to be governed by the same economic principles that govern pure business. Value in health care can only be assessed by weighing cost and quality together. Quality health coverage not only improves care, it saves lives.
UnitedHealth's record in this regard, as measured by the National Committee for Quality Assurance (NCQA), is as revealing as is its animosity toward physicians and hospitals. According to last year's ranking of the country's best health plans by NCQA and US News & World Report, UnitedHealth's highest-rated plan was UnitedHealth New England at 77. UnitedHealth New York was even lower at 125. . .
. . . What makes UnitedHealth's rankings particularly unsettling is the fact they are based on such important criteria as access to care, member satisfaction, disease prevention and treatment.
Posted by Kevin |
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Today's doctor: "Low morale is here to stay"
There seems to be no light at the end of the tunnel:"I think that it is safe to say that no physician is optimistic about the future of medicine at this point," one participant wrote. Others seemed downright hopeless: "One thing that rarely gets mentioned is that, unlike other industries that are cyclical, the practice of medicine continually gets worse and worse, more intolerable, more onerous, with absolutely no hope or reason for any optimism either in the near or remote future."
Posted by Kevin |
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News flash: Most ER visits are non-emergent
What's more, the patients know it as well:Among patients who had recent visits to emergency departments, nearly half believed their health problems could have been handled in a doctor's office, the study said.The key lies in making primary care more attractive to help with access. But is there a will to do this?
Many of the patients said they did not have alternatives, such as same-day appointments with a primary care physician, or evening and weekend appointments; nurse advice lines; or urgent care clinics.
"The survey results validate that for many patients, there are few viable alternatives to the emergency department," said Maribeth Shannon, director of the foundation's hospitals and nursing home program.
Posted by Kevin |
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The free-market is forcing doctors to extend office hours
Extended hours are now "the new norm" in family medicine.
Posted by Kevin |
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Canada always seems to be willing to pump money into the health system
Kind of opposite of what happens here, where reimbursement continues to be cut. An an aside, $170/hr for an ER doc translates into over $350,000 per year assuming a 40-hour work week. Not sure what they're complaining about.
Posted by Kevin |
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A nipple piercing leads to necrotizing faciitis
Sad story in an 18-year old diabetic who had to have one of her breasts removed.
Posted by Kevin |
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Desperate for $$$: A UK hospital wants to start treating pets
Reaching a little far for a new revenue stream:A hospital in Suffolk has been criticised for a fundraising plan to offer radiotherapy to family pets.
Ipswich Hospital proposes using equipment unused at weekends to treat pets with cancer in Saturday clinics.
The hospital aims to raise £50,000 a year from the idea to help pay off debts of more than £24m.
The Patients Association condemned it as "horrifying" but the hospital said no patients would be disadvantaged and there would be no infection risk.
Posted by Kevin |
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Most don't check the source of internet health information
Only 15 percent always checked the source. Scary considering the amount of quackery online.
Posted by Kevin |
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The dangers over Purell and other sanitizers
Dr. Wes:The issues of what we're doing to our immune systems is now coming into question, especially with the high prevalence of asthma in kids these days. We have known about "super bugs" like methicillin-resistant staph. aureus, or c. difficile. One wonders if we're selecting out these critters using antimicrobial products and alcohol-based gels.
Posted by Kevin |
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A major reason why medical mistakes happen: Chaos, not incompetence
Some tips on how to "survive" an ER visit:The main culprit isn’t incompetence but chaos: The nation’s emergency rooms are overburdened and underfunded, treating ever more patients with ever fewer resources. "You don’t want to scare the public, because hundreds of thousands of patients get cared for very well in emergency rooms every day," says Gail Warden, president emeritus of Michigan’s Henry Ford Health System, who chaired a trio of studies of emergency care released in June by the National Academies’ Institute of Medicine. "But the system is stretched, and it could be at a breaking point in three to five years."
Federal law requires that ER doctors and nurses treat everyone who shows up, regardless of ability to pay, but there has never been enough federal money to cover those costs—and that money is dwindling.
Posted by Kevin |
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The most emotionally challenging part of being an ER doc
Separating who really needs narcotics:This is honestly the most emotionally challenging thing I have dealt with as an ER doctor -- not as hard as having a child die on you, but more of an every-day sort of low-level emotional parasite. Some ER docs say "Why bother?" Give 'em what they want -- it's easier and everybody's happy." No complaints to administration that way, either. We euphemistically call these docs the "candy men," but in truth I feel like a more honest appellation would be "pushers."
Posted by Kevin |
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Saturday, October 28, 2006
How to get a doctor's attention; or, how far will drug reps go?
Having returned from a major conference like Pri-Med, the pharmaceutical exhibits are always interesting. Essentially, they are engaged in a "top-this" competition of showmanship and extravagance to woo the physicians in attendance. This led to some comical scenes in this pharmaceutical wonderland.
So, how does one win a physician's attention?
Sleeping all day in your pajamas! (The "O" is for Rozerem - and yes, that was a real person sleeping there. Nice work if you can get it.)
Origami! (Not sure what this has to do with a constipation medication)
Cool magic tricks!
Dressing as a . . . I don't know what! (I think that's triglyceride on the left, HDL on the right; pancreas is below)
Golf!
Masquerading as a coffee shop!
The Truth!
Posted by Kevin |
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Scenes from Pri-Med
From the makers of Vioxx: "We try never to forget that medicine is for the people."
Your handwash, brought to you by Detrol LA
By far the most popular booth, Scarf King
Posted by Kevin |
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UnitedHealth planning to do a major audit on 99215s in 2007
No source here, just something I heard over the weekend. A heads-up that the most physician-unfriendly insurer is up to its old tricks.
Posted by Kevin |
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Sanitizing locker rooms
Apparently a couple of professional sports teams, the Boston Celtics and Cleveland Browns are having an infection outbreak. This has happened before.
Posted by Kevin |
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How the obese is partly responsible for global warming
And people wonder if this negative publicity is a bad thing:Its authors, from the Centers for Disease Control and Prevention, did a sort of back-of-the-envelope calculation of how much extra fuel airlines spend hauling around fatter Americans. The answer, they wrote, based on the extra 10 pounds the average American gained in the 1990’s, is 350 million gallons, which means an extra 3.8 million tons of carbon dioxide.
“People are out scouring the landscape for things that make obese people look bad,” said Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale.
And is that a bad thing? Dr. Jacobson doesn’t think so. "We felt that beyond public health, being overweight has many other socioeconomic implications," he said, which was why he was drawn to calculating the gasoline costs of added weight.
The idea of using economic incentives to help people shed pounds comes up in the periodic calls for taxes on junk food. Martin B. Schmidt, an economist at the College of William and Mary, suggests a tax on food bought at drive-through windows. Describing his theory in a recent Op-Ed article in The New York Times, Dr. Schmidt said people would expend more calories if they had to get out of their cars to pick up their food.
Posted by Kevin |
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"The de-evolution of the GOP"
Chris Rangel talks about Rush Limbaugh, Michael J. Fox, and the de-intellectualization of the Republican Party:Rush knows that these people are out there, that they avoid anything more complicated than their daily lotto numbers, that they have a massive need to feel morally superior rather than intellectually superior, and that by God they want to listen to and be entertained by someone on the same level as they are! Ergo, Rush is their moronic muse. He says publicly, what they think privately and suddenly all is right with the world. I.e. Michael J. Fox is a lying faker and no embryos will be destroyed with taxpayer money so that liberal scientists can start playing God and make clones.
Posted by Kevin |
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Sid Schwab talks about anesthesiologist experiences
On why there is a screen separating the surgeon and anesthesiologist:. . . the screen (still referred to as the "ether screen" is a barrier between the sterile field of the operating table and the unsterile area the anesthesiologist works in. Occasionally it's used like a net on a tennis court: some surgeons like to toss things up there, knowing the anesthesiologist can't return serve.
Posted by Kevin |
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A man blogs about his breast cancer
A blog with photos. (via Unbounded Medicine)
Posted by Kevin |
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Thursday, October 26, 2006
Light blogging
I'm taking the next few days off blogging, I'll be in Boston at Pri-Med East. Feel free to visit some other great medblogs in the meantime.
Posted by Kevin |
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Is Ramadan risking patients' health?
An Egyptian doctor calls out his Islamic fundamentalist colleagues:A growing number of Islamic fundamentalist doctors are putting their patients' health at risk by telling them to fast during the holy month of Ramadan, a prominent Egyptian doctor said.
"We have noticed that brain and heart accidents are on the rise towards the end of Ramadan," Mohammed Ahmed Nasr, a professor of cardiac surgery from the Egyptian National Heart Institute, told AFP.
"In Islam, one who is suffering from an ailment is not compelled to fast but there are bearded doctors who are simply not telling their patients the truth," he said.
Posted by Kevin |
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The med-flight was considered "out-of-network"
The insurance company won't fully cover a hiker's med-flight and he's wondering why. The money quote:But when Jane and I have spent upward of $25,000 on premiums over the last decade to protect us during such emergencies and we're only reimbursed at 40 cents on the dollar, something is wrong.Physician reimbursement also is becoming a fraction of the dollar - join the club.
Posted by Kevin |
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Calling it "malpractice", doctors are being reported for using brand name instead of generic medications
It's happening overseas, can such drastic measures be coming soon Stateside?The Department of Health (DOH) on Tuesday urged residents in Region 12, or Southwestern Mindanao, to immediately report doctors who continue to insist on the use of branded medicines instead of generic products to their patients.
Dr. Abdullah Dumama Jr., DOH Region 12 director, said the health department earlier launched a crackdown against such malpractice, which has reportedly been going on in several parts of the region.
"Concerned parties only need to file a written incident report to our office and we will immediately act on it," he said.
Posted by Kevin |
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A doctor loses a lawsuit after his nurse caused a pneumothorax
Sounds like the procedure was a trigger point injection or some other type of pain-alleviating injection. Caution to who you allow to give the injection, as this suit shows:The suit alleged Barngrover was negligent in training and supervision, and that Peggy Holder, an advanced practice registered nurse, performed below standards when administering the injection. Hins' argued the injection caused one of her lungs to collapse. The other collapsed later at a Columbus hospital, Johnson said.
Posted by Kevin |
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Will the chest CT soon be part of the routine physical?
A recent NEJM study suggests that it may save lives, but there are downsides to routine chest CTs:"Everyone knows we can pick up things better with screening," said Dr. Elliott Fishman, a professor of radiology and oncology at Johns Hopkins Hospital in Baltimore. "But is picking up the same thing as curing? If I pick up a tumor that is one centimeter today and you live five years or I pick it up four years later and you live one year, it’s the same thing."
Even evaluating patients with suspicious CT results can be risky, more dangerous, say, than evaluating women with suspicious lumps on a mammogram, said Dr. David Johnson, deputy director of the cancer center at Vanderbilt University and a past president of the American Society of Clinical Oncology.
In Dr. Henschke’s study, doctors investigated more than 4,000 nodules in patients, finding about 400 early-stage cancers.
"This is not sticking a needle in a breast," Dr. Johnson said. "It is sticking a needle in the chest, where it can collapse a lung." In some cases, that is followed by surgery to further evaluate a lump. "How many people do we subject to needless evaluations?" Dr. Johnson asked.
Posted by Kevin |
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ER observations
A story that is shared in ERs across the country:If you present to the ER with chief complaints of headache AND chest pain, then you are most likely suffering from an anxiety disorder . . .
. . . Don't worry, I'm still going to do the CT scans, ECG, cardiac monitoring, and blood tests anyway. I'll probably even admit you. Maybe you've got Lyme Disease. Probably not. Expect a humongous bill when you are discharged with nothing. It costs a lot to make sure your anxiety disorder isn't something worse, and either of your complaints MIGHT be something serious. However, in my experience, the presence of chest pain and headache together is almost diagnostic of anxiety disorder without any tests at all. Unfortunately the lawyers have trained us to order a gazillion tests and overadmit to cover our butts.
Posted by Kevin |
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No one cares that alternative medicines doesn't work
Another sign that quackery trumps intellectualism? Aetiology comments:It's hard to argue with anecdotes like that, and people taking these types of supplements in spite of the research, rather than because of it. Ironically, of course (as Orac can tell you), many who take these alternative meds do so because of a distaste for "big pharma" or "corporate medicine," despite the fact that alternative medicine is just as much (if not more) of a moneymaker.
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Wednesday, October 25, 2006
Sword swallowing X-rays
A bizarre collection of sword swallowing chest x-rays.
Posted by Kevin |
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Sending infants to psychiatrists
I wonder when the medications to treat these infant diseases will start to come:Therapists are increasingly moving their treatments from the couch to the crib. While the field of infant mental health, which encompasses the study of children from birth through age three, has been around for decades, new research on everything from brain development to maternal depression is giving it a boost. A widely used mental health and development diagnostic manual for infants was revised last year for the first time since 1994 to include two new subsets of depression, five new subsets of anxiety disorders (including separation anxiety and social anxiety disorders) and six new subsets of feeding behavior disorders (including sensory food aversions and infantile anorexia).More here.
Posted by Kevin |
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10 first-aid myths
Examples: don't slather butter on a burn; don't suck venom from a snakebite; don't pee on a jellyfish sting.
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"I am not a perfect physician"
Bad outcomes sometimes do happen. To prevent his, the patient has to bear some responsibility:This news just in: I am not a perfect physician. I thought I was, but I am not. When I take care of patients I sometimes make mistakes, do the wrong thing, forget to do the right thing, or don’t do everything I should.
You can tell me I’m a bad physician, make me hate myself, boil me in malpractice oil, send me back to medical school for the rest of my life, and I still will not practice perfect medicine. To increase my odds of doing that I need help, but not just any help; I need my patients’ help to get it right more of the time.
In fact, as a physician I don’t just need your help with that; I need you to see that as your job as a patient. You can say that’s putting the burden of my inadequate performance unfairly on your shoulders, and call the Board of Medicine to report a quack ducking his responsibility, but I don’t care about that. What I do care about is my patients, enough to tell them I’m not perfect, and that it is their job to help me take better care of them.
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Did the anesthesiologist hold up an emergent C-section?
An OB wrongful death suit where a C-section wasn't done soon enough. Was it because they had to wait for the anesthesiologist?The prosecution argues Evans waited too long to perform a c-section.
Tuesday's testimony centered around 30 critical minutes where protocol says a c-section should begin within a half hour of a patient's deteriorating condition.
"She was bleeding the way she was bleeding, we have to do something and they failed to do it," said Michael Drebitko, Caleb's grandfather.
Expert witnesses testified that if Dr. Jason Evans had been more proactive when Casey Taylor began bleeding, baby Caleb would "most likely" be alive today...a tough pill for Drebitko to swallow.
"Very difficult...very."
The defense argues Evans could not begin the c-section until the anesthesiologist arrived at the hospital, but Drebitko says the blame still falls on Evans.
Posted by Kevin |
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Bio-identical hormones are still hormones
TBTAM is one of many who takes Suzanne Somers' anti-aging book to task:More than a few patients have arrived to their appointment toting Suzie's book. It can take a lot to get them to be specific about what it is they feel they need hormones to treat, and to understand that natural estrogen is indeed estrogen, with all its risks and benefits. And that we are all going to get old (and look old) someday, estrogen or no estrogen.
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